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How Often Are Workers’ Comp Claims Disputed or Denied?

According to The Texas Tribune, nearly half of all workers’ compensation claims are disputed or denied. The Texas Department of Insurance’s (TDI) Division of Workers’ Compensation (DWC) handles all disputes relating to workers’ comp.

Unfortunately, Crystal Davis experienced firsthand the difficulty in disputing coverage with a workers’ comp insurance company. Davis’s husband, Wayne, worked for Burger King as a “Sales, Profit and Operations Coach.” His job required traveling on the road most of the time.

In September of 2012, Wayne was killed while driving to a Burger King store. A distracted driver had crossed over into his lane and hit him head on. His death left Crystal the jobless parent of two young children.

Crystal filed for workers’ comp through her husband’s employer Burger King. However, Burger King’s insurer ACE American Insurance Company denied Crystal’s claim. ACE argued that although her husband was driving a company vehicle to a company-sanctioned job, he was not on the clock.

This started the long dispute process between Crystal and ACE.

How Often Do Employees Win Serious Workers’ Comp Disputes?

In the state of Texas, the pro business attitude usually favors the employer and not the employee. For example, the Office of Injured Employee Counsel (OIEC) says that employees win less than a third of the disputes within the DWC.

Although it has been a difficult process, Crystal is lucky that Burger King has workers’ comp insurance, because Texas is the only state that does not require employers to obtain that type of coverage.

However, as we will explain next week, Crystal’s attempts to take on the big insurance company by herself proved to be a difficult and time-consuming process. In other words, although her husband’s workplace offered workers’ comp, she had to fight the insurance company every step of the way.